OCD vs. Anxiety: How to Tell the Difference

What general anxiety looks like

Everyone worries. The National Institute of Mental Health (NIMH) describes generalized anxiety disorder (GAD) as something more: worry and nervousness that are excessive, hard to control and stronger than the situation calls for, and that continue for months or years instead of fading once a stressful event has passed.

The worries in GAD tend to be about ordinary parts of life. Adults often worry about job security, health, finances, the well-being of family members, being late and getting everything done at home. Young people often worry about school, activities, friendships and the future.

Anxiety also shows up in the body. NIMH lists feeling restless or on edge, tiring easily, trouble concentrating, irritability, headaches, muscle aches, stomachaches and trouble sleeping among the symptoms.

What OCD looks like

NIMH describes OCD as a long-lasting condition in which a person has uncontrollable and recurring thoughts (obsessions), engages in repetitive behaviors (compulsions), or both. The symptoms are often time-consuming and can cause real distress or get in the way of daily life.

Obsessions are thoughts, urges or mental images that are unwanted and keep coming back. NIMH's examples include fear of germs or contamination, fear of losing or misplacing something, worry about losing control over one's behavior, unwanted aggressive thoughts, unwanted taboo thoughts involving sex, religion or harm, and a need to have things symmetrical or in perfect order.

Compulsions are the repetitive things a person feels driven to do, often in response to an obsession. Examples include excessive cleaning or handwashing, arranging items in a precise way, repeatedly checking things such as a lock or an oven, counting, and praying or repeating words silently. Some compulsions, such as silent counting or repeating words, are not visible to anyone else.

How to tell them apart

From the inside, both can feel like a mind that will not settle. A few differences can help you describe what is happening.

• What the thoughts are about. Worry in GAD usually attaches to everyday matters such as work, health, money and family. Obsessions are unwanted thoughts that keep returning, with themes such as contamination, harm or order.
• What follows the thought. In OCD, a person often feels driven to do something to ease the distress: check, wash, count, repeat or arrange. Rituals like these are not part of how NIMH describes generalized anxiety.
• What the behavior gives back. NIMH notes that people with OCD do not get pleasure from their compulsions, though they may feel brief relief from the anxiety.
• How much control there is. People with OCD cannot control their obsessions or compulsions, even when they know they are excessive.
• How much time it takes. NIMH says people with OCD generally spend more than 1 hour a day on obsessions or compulsions.

Common misconceptions

"OCD means being neat." Liking a tidy desk is a preference. NIMH is clear that not all habits or repeated behaviors are compulsions, and that everyone double-checks things sometimes. The difference is the lack of control, the time involved, the absence of pleasure and the problems it causes in daily life.

"OCD is only about germs and handwashing." Contamination fears are one theme among many. Unwanted thoughts about harm, religion or sex are also among the examples NIMH gives, and they are thoughts a person does not want and did not choose.

"It is one or the other." NIMH notes that people with OCD often also have a mood or anxiety disorder. It is possible to live with both, which is one reason self-diagnosis from a list is unreliable. This article can help you find words for your experience. Only a qualified professional can assess what is going on.

"A child would tell me." NIMH points out that children may not realize their behavior is out of the ordinary, and that parents or teachers typically notice the symptoms first. Symptoms can begin at any time and usually start between late childhood and young adulthood.

Treatments that help

Treatment can help with both, and talk therapy is a main treatment for each. For generalized anxiety, NIMH says cognitive behavioral therapy (CBT) is commonly used. NIMH also names acceptance and commitment therapy, and healthy habits such as enough sleep, exercise and less caffeine as a support alongside treatment, not a replacement for it.

For OCD, NIMH also points to CBT, and in particular to a specific type called exposure and response prevention (ERP). In ERP a person is gradually exposed to the things that trigger their obsessions while learning not to carry out the usual compulsion. This is why telling the two conditions apart matters: the skills used for general worry are not the same thing as ERP.

NIMH names medication as a treatment for both conditions as well. Whether medication makes sense for you is a decision to make with a prescriber, and it should not be started, stopped or changed without one.

If distress ever becomes a crisis, or you are thinking about harming yourself, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources page lists more options.

How we can help

Therapists on our team work with anxiety and with OCD, and CBT is among the approaches they use. Not every therapist uses every approach, so if you think OCD may be part of the picture, tell us at your consultation and ask about experience with exposure and response prevention. Our anxiety therapy page describes how we work, and we also see young people through teen therapy.

All sessions are by secure video, and clients must be physically in Pennsylvania, West Virginia or Arizona during a session. We match you with a therapist licensed where you live.

You can start with a free 15-minute consultation on our booking page, and check coverage on our insurance and fees page. Whatever name fits your experience, support is available and treatment can help.